Abstract
BackgroundIntussusception is the most common abdominal emergency in children. The first line treatment of uncomplicated pediatric intussusception is enema reduction. Until now, there have been no multi-center studies comparing the effectiveness and safety of UGHR and FGAR in the treatment of pediatric intussusception. The aim of this study was to compare the effectiveness and safety of the two most commonly used enema methods of pediatric intussusception: ultrasound-guided hydrostatic reduction (UGHR) and fluoroscopy-guided air reduction (FGAR).MethodsFrom November 1, 2017 to October 31, 2018, we conducted a multi-center, prospective, cohort study. Children diagnosed with intussusception in four large Children’s Medical Centers in China were divided into UGHR and FGAR groups. Stratified analysis and subgroup analysis were used for further comparison. The success and recurrence rates were used to evaluate the effectiveness of enema reduction. The perforation rate was used to evaluate the safety of enema reduction.ResultsA total of 2124 cases met the inclusion criteria (UGHR group: 1119 cases; FGAR group: 1005 cases). The success and recurrence rates in the UGHR group were higher than in the FGAR group (95.80%, 9.28% vs. 93.13%, 10.65%) (P < 0.05, P > 0.05), respectively. The perforation rate in the UGHR group was 0.36% compared with 0.30% in the FGAR group (P > 0.05). Subgroup analysis showed the success rates in the UGHR group were higher than in the FGAR group of patients with onset time between 12 and 24 h (95.56% vs. 90.57%) (P < 0.05). Of patients aged 4 to 24 months, the success rates in the UGHR group were also higher than in the FGAR group (95.77% vs. 91.60%) (P < 0.05). Stratified analysis showed the success rates in the UGHR group were higher than in the FGAR group in patients with the symptom of bloody stool (91.91% vs 85.38%) (P < 0.05).ConclusionsUGHR and FGAR are safe, nonsurgical treatment methods for acute pediatric intussusception. UGHR is superior to FGAR, no radiation risk, its success rate is higher, without a difference in perforation rate, especially for patients aged 4–24 months.Level of evidenceLevel II.
Highlights
Intussusception is one of the most common abdominal emergencies in infants and toddlers, typically occurring in infants between 4 and 10 months
ultrasound-guided hydrostatic reduction (UGHR) is superior to fluoroscopy-guided air reduction (FGAR), no radiation risk, its success rate is higher, without a difference in perforation rate, especially for patients aged 4–24 months
From November 2017 to October 2018, a total of 2591 intussusception cases were collected, according to the inclusion criteria; 2124 cases were enrolled in this study, including 1119 cases in the UGHR group and 1005 cases in the FGAR group (Fig. 1)
Summary
Intussusception is one of the most common abdominal emergencies in infants and toddlers, typically occurring in infants between 4 and 10 months. The treatment methods of pediatric intussusception are divided into two types: surgical treatment or nonsurgical treatment. For uncomplicated pediatric intussusception, imaging-guided enema reduction is the internationally recognized, standard, nonsurgical treatment method [3], which can cure the vast majority of intussusception cases. Intussusception is the most common abdominal emergency in children. The first line treatment of uncomplicated pediatric intussusception is enema reduction. There have been no multi-center studies comparing the effectiveness and safety of UGHR and FGAR in the treatment of pediatric intussusception. The aim of this study was to compare the effectiveness and safety of the two most commonly used enema methods of pediatric intussusception: ultrasound-guided hydrostatic reduction (UGHR) and fluoroscopy-guided air reduction (FGAR)
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